Safety of Romiplostim (Nplate®) Following UCBT

Inclusion Criteria:

Any patient who has undergone a single or double umbilical cord blood transplant (UCBT) except those with primary myelofibrosis.

Those with acute leukemia must be in remission at the time of transplant
Must have achieved neutrophil engraftment (defined as an ANC >500 for three consecutive days) and be off daily G-CSF prior to starting romiplostim. Intermittent G-CSF is allowed.
Failure to achieve platelet engraftment (defined as platelet count ≥20x10^9/L on 3 consecutive measurements without transfusion for 7 days) by day +28 post UCBT
Between day +28 and day +42 status post myeloablative or nonmyeloablative UCBT (single or double cord blood transplant)
Age ≥ 18 years

Adequate organ function within 7 days of enrollment defined as:

Creatinine: ≤ 2.0 mg/dL
Hepatic: SGOT and SGPT < 5 x upper limit of institutional normal (ULN)
Women of child bearing potential agree to use effective contraception during therapy and for 4 months after completion of therapy
Voluntary written consent

Exclusion Criteria:

Known pregnancy - Pregnancy Category C: there are no adequate and well-controlled studies of romiplostim in pregnancy
Recurrence of AML or myelodysplastic syndrome on bone marrow evaluation done within 21 days of enrollment
Presence of clinically significant bone marrow fibrosis on the bone marrow examination immediately prior to UCBT
Patients requiring more than one platelet transfusion per day
History of an allergy to romiplostim